Study of the relation between body weight and functional limitations and pain in patients with knee osteoarthritis / Estudo da relação entre o peso corporal e o quadro de limitação funcional e dor em pacientes com osteoartrite de joelho

ABSTRACT Objective To assess the influence of the body weight in functional capacity and pain of adult and elderly individuals with knee osteoarthritis. Methods The sample consisted of 107 adult and elderly patients with knee osteoarthritis divided into two groups (adequate weight/adiposity and excessive weight/adiposity) according to body mass index and percent of body fat mass, assessed by electric bioimpedance. Subjects were evaluated for functional mobility (Timed Up and Go Test), pain, stiffness and function (Western Ontario and MacMaster Universities Osteoarthritis Index − WOMAC), pain intensity (Visual Analogue Scale − VAS) and pressure pain tolerance threshold (algometry in vastus medialis and vastus lateralis muscles). Data were analyzed with Statistical Package of the Social Sciences, version 22 for Windows. Comparisons between groups were made through Student's t test, with significance level set at 5%. Results There was predominance of females in the sample (81.3%), and mean age was 61.8±10.1 years. When dividing the sample by both body mass index and adiposity, 89.7% of them had weight/adiposity excess, and 59.8% were obese. There was no difference between groups regarding age, pain intensity, pressure pain tolerance threshold, functional mobility, stiffness and function. However, pain (WOMAC) was higher (p=0.05) in the group of patients with weight or adiposity excess, and pain perception according to VAS was worse in the group of obese patients (p=0.05). Conclusion Excessive weight had negative impact in patients with osteoarthritis, increasing pain assessed by WOMAC or VAS, although no differences were observed in functionality and pressure pain tolerance.

RESUMO Objetivo Avaliar a influência do peso corporal na capacidade funcional e na dor de adultos e idosos com osteoartrite de joelho. Métodos A amostra foi constituída por 107 pacientes adultos e idosos com osteoartrite do joelho, divididos em dois grupos (peso/adiposidade adequados e peso/adiposidade em excesso), de acordo com o índice de massa corporal e a porcentagem de adiposidade corporal, e avaliados por bioimpedância elétrica. Os sujeitos foram avaliados quanto à mobilidade funcional (Timed Up and Go), dor, rigidez e função (Western Ontario and McMaster Universities Osteoarthritis Index − WOMAC), intensidade da dor (Escala Visual Analógica - EVA) e limiar de limiar de dor à pressão (algometria nos músculos vasto medial e vasto lateral). Os dados foram analisados pelo Statistical Package of the Social Sciences, versão 22 para Windows. As comparações entre os grupos foram feitas por meio do teste t de Student, com nível de significância estabelecido em 5%. Resultados Houve predomínio de mulheres na amostra (81,3%), com média de idade de 61,8±10,1 anos. Ao dividir a amostra por índice de massa corporal e adiposidade, 89,7% apresentaram peso/adiposidade em excesso, e 59,8% eram obesos. Não houve diferença entre os grupos quanto a idade, intensidade da dor, limiar de dor à pressão, mobilidade funcional, rigidez e função. Entretanto, a dor (WOMAC) foi maior (p=0,05) no grupo de pacientes com excesso de peso ou adiposidade, e a percepção da dor pela EVA foi pior no grupo de pacientes obesos (p=0,05). Conclusão O peso em excesso teve impacto negativo em pacientes com osteoartrite, aumentando a dor avaliada pelo WOMAC ou pela EVA, embora não tenham sido observadas diferenças na funcionalidade e na tolerância à dor sob pressão.

Prevalence of temporomandibular disorders in postmenopausal women and relationship with pain and HRT

Abstract The prevalence of temporomandibular disorders (TMD) is higher in females, reaching their high peak during reproductive years, probably because of the action of some female hormones, which alter pain threshold. This study aimed to investigate the prevalence of TMD in postmenopausal women and its relationship with pain and hormone replacement therapy (HRT). In total, 284 patients were evaluated and classified using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Pain was measured using the Visual Analogue Scale (VAS), and patients were also asked about the use of HRT. All data was analyzed using analysis of variance (ANOVA) and chi-square test. In total, 155 subjects did not have TMD and 129 had TMD; TMD group patients were classified according to RDC/TMD axis I classification as follows: muscle disorder group (1.6%), disk displacement group (72.87%), and arthralgia, osteoarthritis, and osteoarthrosis group (37.98%). Pain was registered in 35 patients who belonged to the TMD group, while 48 patients reported the use of HRT. There was a similar percentage of TMD and non TMD patients; moreover, the use of exogenous hormones was no associated with TMD, suggesting that there is no influence on the pain threshold.

Obesidade em idosos do Município de São Carlos, SP e sua associaçãocom diabetes melito e dor articular / Obesity among older people of the City of São Carlos, SP, Brazil, and its association with diabetes mellitus and joint pain

Este estudo tem por objetivo verificar a prevalência de obesidade e sua associação com diabetes melito (DM) e dores articulares na população idosa residente em São Carlos, SP. Foram avaliadas 227 idosas (média de idade 69,6±6,8 anos) e 172 idosos (69,4±6,7 anos) quanto ao índice de massa corporal (IMC) e questionados quanto à presença de diabetes e dor articular. Os dados foram tratados estatisticamente. Os resultados mostram que 73,6% das idosas e 66,9% dos idosos apresentavam sobrepeso ou eram obesos. As médias de IMC foram maiores nos indivíduos com idade inferior a 75 anos. Entre as mulheres da amostra foi encontrada associação entre a presença de DM, dores no pé, tornozelo e joelho e a condição“obesa”. No grupo masculino, a condição obeso só apresentou associação com a presença de DM. Foi pois constatada associação entre obesidade e presença de DM. Mulheres idosas apresentam maior prevalência de obesidade e associação entre dores articulares e excesso de peso corporal.

The aim of this study was to assess prevalence of obesity and its association with diabetes mellitus (DM) and joint pain among elderly dwellers in the city of São Carlos, SP, Brazil. A total of 399 aged people – 227 women (mean age 69.6±6.8) and 172 men (mean age 69.4±6.7) – were assessed as to body mass index (BMI) and were questioned whether they had diabetes and joint pain. Data were statistically analysed. Results showed that 73.6% of the women and 66.9% of the men were overweight or obese; BMI values were higher in subjects aged under 75. Among women, associations were found between the obese condition, presenceof diabetes, and foot, ankle and knee pain. In the male group, the obese condition presented association only with presence of diabetes. An association was hence found between obesity and DM. Prevalence of obesity was greater in elderly women, who also presented association between joint pain and high BMI values.

Jones criteria and underdiagnosis of rheumatic fever.

OBJECTIVE: The authors attempt to determine whether typical clinical and laboratory manifestations of acute rheumatic fever (ARF) are in accordance to what has been traditionally described and how useful the Jones criteria are for diagnosis. METHODS: Data from 81 cases of ARF were retrospectively collected. Inclusion criteria: 5 to 15 years of age and diagnosis of ARF confirmed by 2 or more rheumatologists, sustained for at least 6 months and two or more visits. RESULTS: Girls had more chorea (23/50.0% vs. 5/14.3%)(p< 0.0001). Cardiovascular (65/80.2%) and joint involvements (63 / 77.8%) were the most frequent manifestations. Fever was noted in roughly half of the patients. Arthritis was more frequent than arthralgia (47/58.0% vs. 16/19.8%, respectively) (p< 0.0001); however, no specific pattern of joint involvement was found to be more prevalent. Mitral insufficiency was the most frequently detected echocardiographic sign (53 / 93.0%) and its association with aortic insufficiency was noted in 27 / 47.4% patients. Only 24 / 29.6% patients fulfilled Jones criteria for ARF requiring an evidence of previous group-A streptococcal infection (GASI). When compulsory GASI was disregarded, this number rose to 71/87.7% patients (p< 0.0001). CONCLUSION: Girls were more affected by chorea; heart valves and joints were equally affected and represented the major clinical features; no specific pattern of joint involvement (eg.: migratory arthritis) could be labeled as typical; and strict adherence to Jones criteria, with compulsory documentation of a previous GASI, may lead to underdiagnosis of ARF.

Osteoartrite experimental em ratos: efeito de sulfato de glicosamina e sulfato de condroitina sobre a incapacitação articular e a lesão da cartilagem articular / Experimental osteoarthritis in rats: evaluation of antinociceptive and chondroprotective effects of glucosamine sulfate and chondroitin sulfate

Avaliou-se o efeito antinociceptivo e condroprotetor de sulfato de glicosamina e condroitina em um modelo de osteoartrite por transeccção do ligamento cruzado anterior em ratos. Os animais receberam sulfato de glicosamina ou sua combinação com sulfato de condroitina por 100 dias. A dor articular foi avaliada pelo tempo de suspensão da pata operada durante a deambulação e o dano articular por análise histopatológica dos côndilos femorais e quantificação de glicosaminoglicanos na cartilagem. A combinação mostrou-se eficaz tanto na redução da dor como do dano articular, sugerindo melhora funcional e estrutural com o uso da associação de sulfato glicosamina e condroitina na osteoartrite.

Antinociceptive and chondroprotective effects of glucosamine and chondroitin sulphate were evaluated in the osteoarthritis model of anterior cruciate ligament transection in rats. Animals received glucosamine sulphate or its combination with chondroitin sulphate for 100 days. Joint pain was evaluated by paw elevation time, and articular damage by histopathological analysis of femoral condyles and cartilage quantification of glycosaminoglycans. The combination of the compounds was efficient in reducing both joint pain and joint damage, suggesting functional and structural benefits of the combination of glucosamine and chondroitin sulphate in osteoarthritis.

Avaliação eletromiográfica dos músculos estabilizadores da patela durante exercício isométrico de agachamento em indivíduos com síndrome da dor femoropatelar / Electromyographic activity evaluation of the patella muscles during squat isometric exercise in individuals with patellofemoral pain syndrome

O objetivo deste trabalho foi comparar a atividade elétrica dos músculos vasto medial oblíquo (VMO), vasto lateral longo (VLL) e vasto lateral oblíquo (VLO) durante os exercícios isométricos de agachamento wall slide a 45º (WS 45º) e 60º (WS 60º) de flexão do joelho. Foram avaliadas 15 mulheres clinicamente saudáveis e 15 mulheres com síndrome da dor femoropatelar (SDFP). Os registros eletromiográficos foram obtidos por eletrodos ativos simples conectados a um eletromiógrafo durante a contração isométrica voluntária máxima (CIVM) do WS 45º e WS 60º. Os dados foram analisados pela média dos valores do root mean square (RMS) do sinal eletromiográfico, normalizado pela média do RMS obtido no agachamento a 75º de flexão do joelho. A análise estatística empregada foi o teste ANOVA two way (p < 0,05) e teste de Duncan post hoc (p < 0,05). Os resultados revelaram que o exercício WS 60º apresentou maior atividade elétrica nos músculos VMO, VLL e VLO quando comparado com o WS 45º, para os grupos controle e SDFP. Durante o WS 60º, para o grupo controle, não foram observadas diferenças na atividade dos músculos VMO, VLO e VLL, sugerindo um equilíbrio na atividade elétrica destes músculos, enquanto que no WS 45º o músculo VLL apresentou maior ativação quando comparado com os músculos VMO e VLO. Para o grupo SDFP, esse equilíbrio entre as porções medial e lateral do músculo quadríceps foi observado em ambos os exercícios. Esses dados sugerem que WS 60º, para o grupo controle, pode ser mais efetivo para programas de fortalecimento muscular. Contudo, para o grupo com SDFP, ambos os exercícios podem ser indicados durante o programa de reabilitação. Além disso, a ausência de diferenças na atividade eletromiográfica dos músculos VMO, VLO e VLL entre os grupos, neste estudo, sugere que o desequilíbrio muscular pode não ser um fator predisponente da SDFP.

Effects of a Taping Method on Pain and ROM of the Knee Joint in the Elderly / 간호학회지

PURPOSE: This study was to investigate the effects of a taping method on pain and ROM of the knee joint in the elderly. METHOD: The subjects were seniors registered in a senior welfare center in D city. An experimental group of 30 persons and acontrol group of 33 persons were chosen and according to the proper conditions and a knee pain score was marked from 1-5 on a Numerical Pain Rating Scale. For the experimental group, the taping method was conducted three times a week for four weeks (twelve times in all) but the control group did not receive taping.. The measuring instrument of knee pain was a numerical pain rating scale from 0 to 10 and the ROM score was the average value of three measured values witha goniometer. The data was analyzed with SPSS WIN 10.0 using an chi-square-test, t-test,repeated measures ANOVA, and time contrast. RESULT: Knee joint pain was significantly decreased in the experimental group over that of the control group (p=.001). In addition, knee joint ROM of the experimental group was significantly improved over that of the control group (p=.001). CONCLUSION: It was proven that the taping method was effective for pain relief and increasing ROM of the knee joint in the elderly.

Prevalência e fatores associados a dor em bailarinos profissionais / Prevalence and associated factors with pain in professional dancers

PURPOSE: To investigate factors associated to pain in ballet dancers as well its prevalence. METHODS: We conducted an analytical cross-sectional study among 141 professional ballet dancers from the main capitals of Northeastern Brazil. In order to evaluate the symptoms of pain we used Portuguese official versions of the McGill Protocol and the Pain Inventory of Wisconsin. For statistical analysis of the results we performed a descriptive assessment, followed by T-Student and Pearson's Correlation tests (taking a value of p < 0.05). RESULTS: We observed high levels of pain tolerance in 70.2% of the subjects, in which the intensity varied from moderate to severe. The lumbar region was the most affected (85.8%). We observed positive correlations concerning the intensity degree of pain with activities such as dancing (60.3%), sleeping (28.4%), marching (20.6%), general activities (32.6%), mood (27.7%), and personal relations (16.3%). CONCLUSION: We observed a high prevalence of pain in professional ballet dancers from the main Northeastern capitals, attacking mostly the lumbar region, followed by knees, neck, hip and feet, with substantial interference of pain symptoms in several activities of the personal and professional lives of these people.

Movimentos mandibulares na fala: eletrognatografia nas disfunções temporomandibulares e em indivíduos assintomáticos / Mandibular movements in speech: electrognathography in temporomandibular disorders and asymptomatic individuals

O objetivo do estudo foi verificar a caracterização dos movimentos mandibulares na fala, para o Português Brasileiro, com uso da eletrognatografia computadorizada, em 135 indivíduos adultos com disfunções temporomandibulares e assintomáticos. Foram obtidos valores de amplitude de abertura, retrusão, protusão, lateralidade, velocidade de abertura e fechamento mandibular para os dois grupos, além da verificação quanto aos graus de dor / The aim of this study was to verify the characterization of the mandibular movements during speech, for the Brazilian Portuguese language, using computerized Electrognathography. One hundred and thirty-five adults, with and without temporomandibular disorders were analyzed. The mean values of amplitude during opening, retrusion, protrusion, translations and velocity were obtained, including the degrees of pain. Results showed that temporomandibular disorders...

Tratamiento conservador de los síndromes dolorosos patelofemorales / Conservative treatment for painful patello-femoral syndromes

Los síndromes dolorosos patelofemorales pueden ser tratados inicialmente de manera no quirúrgica en la mayoría de los casos. El éxito del tratamiento no quirúrgico depende de la severidad de la patología tanto como del protocolo de tratamiento elegido. Se presentan los principales tipos de tratamiento no quirúrgico para el dolor patelofemoral empleados en Sports Clinic. Se incluye modificación de las actividades habituales, medicación y programa completo de terapia física y rehabilitación.

Valor pronóstico del índice de Sharp en la respuesta clínica y de laboratorio a un pulso intravenoso de metilprednisolona en pacientes con artritis reumatoídea / Prognostic value of Sharp index in the clinical and laboratory response to an iv methylprednisolone pulse in patients with rheumatoid arthritis

Background: No reliable variables to predict clinical or laboratory response to treatment in patients with rheumatoid arthritis were available until recently. Aim: To asses the potential predictive value of the Sharp's modified radiographic joint damage index for the assessment of clinical and laboratory response to a methylprednisolone i.v. pulse. Patients and Methods: Twenty-two patients suffering from rheumatoid arthritis received a single i.v. pulse of 1 g of methylprednisolone. Hand X-rays were taken at baseline and blindly scored by two trained radiologists. Clinical and laboratory variables were assessed at baseline and at weekly intervals up to 30 days plus a 60 days final evaluation. Improvement was defined as a 50 percent amelioration in 4 variables. Results: Assessment of radiographic scores had a high correlation between and within observers (intraclass correlation= 0.998). Sharp score did not reach statistical significance as global predictor for the inflammatory variable response to methylprednisolone. However, when the number of swollen joints was taken into account, patients with a low erosive score (Sharp ² 50) had a more prolonged clinical response, than patients with higher erosive score (Sharp >50) (Fisher test p= 0.023). It is of clinical importance to point out that among patients with high Sharp score there were also responders who reached a high level of improvement. A statistically significant correlation between the basal PCR serum titers and the radiographic score (p< 0.02) was observed. Conclusions: The number of swollen joints and other variables that consider joint structural changes should be considered for the assessment of rheumatoid arthritis patients

Efficacy of arthrocentesis, splint therapy and MRI assessment in management of patients with temporomandibular joint disorders

To evaluate clinical biochemical and imaging assessment of the efficacy of lavage [arthrocentesis] of proinflammatory cytokines in the synovial fluid in symptomatic TMJ with or without the use of anterior repositioning splint. Radiodiagnosis Department. Faculty of Medicine, Alexandria University, Maxillofacial surgery, Prosthodentics and Oral surgery Departments, Faculty of Dentistry, Alexandria University. 20 patients [12 females and 8 males] with symptoms of TMJ pain, joint noise, limitation of joint opening, tenderness located in the articular region. all patients underwent full clinical examination and diagnostic imaging [panoramic radiographs] and MRI. patients were grouped into two; [group I] those treated by arthrocentesis of TMJ [the proinflammatory cytokines alone] and [group 2] those were treated by arthrocentesis and anterior repositioning splint therapy. arthrocentesis were done two times with interval of 6 weeks. MRI were done before treatment and after two months from treatment. the patients were divided into two groups both groups were treated with anhrocenzesis mandibular hard acrylic resin repositioning splint constructed for group 2 and was worn after arthrocentesis. clinical, biochemical and radiological imaging [MRI] evaluations were carried out to assess the efficacy of arthrocentesis [lavage] of the inflammatory cytokines in the synovial fluid of the symptomatic TMJ disc position and erosions can be fully assessed by MRI and both groups demonstrated marked clinical improvements after treatment mainly of group 2 and this match with the improvement of the disc position identified by MRI. patients with disc erosions were the least to improve. 1. the combination treatment of arthrocentesis of TMJ and mandibular repositioning splint give the advantages of pain relief and considered as the treatment modality of choice before surgical intervention to avoid the morbidity associated with surgery. 2. MRI is the only direct objective, very sensitive and accurate imaging modility to test the validity and effect as well as the prognosis of lavage [arthrocentesis] and prothesis treatment [splint therapy] of TMJ disorders. 3. erosion of the disc is a sign of bad omen in the way of anatomical repositioning of the disc after different modalities of treatment